Individual provider Active NPI

Anthony Hartzog, PA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1457902066
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
028159 Issued in NY
Practice address
622 W 168TH St
New York, NY 10032-3720
Phone
(212) 305-6059
NPI assigned
Sep 25, 2019
Last updated
Sep 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA061113 PA
Physician Assistant 363A00000X 028159 NY Primary

Addresses

Primary practice location

622 W 168TH St
New York, NY 10032-3720

Mailing address

622 W 168TH St
New York, NY 10032-3720

Other practice location 1

3600 Forbes Ave Ste 10040
Pittsburgh, PA 15213-3410
Phone (412) 647-8287

Other practice location 2

100 Moffett Run Rd
Aliquippa, PA 15001-9199
Phone (724) 378-4461

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/ Health Information Exchange (HIE)
Direct Messaging Address CWID@direct.nyp.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200116000601 PA Practitioner - Physician Assistant 0648605832 Reassigns benefits to 3 organizations
I20221206001205 NY Practitioner - Physician Assistant 0648605832 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

770 E 176TH St
Bronx, NY 10460-4617
Phone (718) 583-5150

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
028159NYMDClinical Psychologist
MA061113PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Pittsburgh Physicians CurrentSince Dec 1, 2019 Accepting new patients
Ars Treatment Centers, P.C. CurrentSince Jul 23, 2020 Accepting new patients
Vocational Instruction Project Community Services Inc CurrentSince Apr 18, 2025 Accepting new patients
St Clair Medical Services, Inc. CurrentSince Dec 28, 2021 Accepting new patients
St Clair Medical Services Inc CurrentSince Dec 28, 2021 Accepting new patients
Trustees of Columbia University in the City of New York Physician Assistant CurrentSince Aug 12, 2022 Accepting new patients
University of Pittsburgh Physicians CurrentSince Dec 1, 2019 Accepting new patients

Locations

770 E 176th St
Bronx, NY 10460
Phone (718) 583-5150

770 E 176th St
Fl 3
Bronx, NY 10460
Phone (718) 583-5150

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

622 W 168th St
#2260
New York, NY 10032
Phone (212) 305-6204

220 S Main St
Ste A
Butler, PA 16001

1000 Bower Hill Rd
Pittsburgh, PA 15243
Phone (412) 344-6600

200 Lothrop St
Pittsburgh, PA 15213
Phone (412) 647-3553

3600 Forbes Ave
Ste 10040
Pittsburgh, PA 15213
Phone (412) 647-0543

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1457902066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-6059"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 Forbes Ave Ste 10040",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152133410",
            "country_code": "US",
            "telephone_number": "412-647-8287",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Moffett Run Rd",
            "address_purpose": "LOCATION",
            "city": "Aliquippa",
            "state": "PA",
            "postal_code": "150019199",
            "country_code": "US",
            "telephone_number": "724-378-4461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARTZOG",
        "first_name": "ANTHONY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-25",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA061113",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "028159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "622 W 168th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "622 W 168th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CWID@direct.nyp.org",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Address",
            "address_1": "622 W 168th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.